| NPI | 1932345899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY5666) |
| Enumeration Date | 2008-12-25 |
| Last Update Date | 2009-04-19 |